Healthcare Provider Details

I. General information

NPI: 1023133352
Provider Name (Legal Business Name): TAMARA JOYCE WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ALEXIAN DR STE 110
SAN JOSE CA
95116-1901
US

IV. Provider business mailing address

506 MAYELLEN AVE
SAN JOSE CA
95126-3313
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-6518
  • Fax: 408-272-6569
Mailing address:
  • Phone: 408-292-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW13833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: